Intervertebral implant and device for inserting an intervertebral implant

ABSTRACT

An intervertebral implant has a hollow space formed within the implant and accessible through an elongate opening extending through a recessed portion of the side wall, and the hollow space is shaped to receive an engagement portion of a drive shaft of an insertion tool; and the intervertebral implant includes at least two guiding surfaces facing each other and being configured for sliding engagement by a portion of a sleeve of the insertion tool movably holding the drive shaft.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication Ser. No. 62/210,245, filed on Aug. 26, 2015, and also claimspriority to European Patent Application No. 15 182 602.1, filed on Aug.26, 2015, the entire content of each of which is hereby incorporated byreference.

BACKGROUND

The present invention relates to an intervertebral implant having a topsurface configured to engage a first vertebral body, a bottom surfaceconfigured to engage a second vertebral body and a side wall connectingthe top surface and the bottom surface, and a hollow space formed withinthe implant and accessible through an elongate opening extending througha portion of the side wall.

The invention further relates to a device for inserting theintervertebral implant into a body, comprising a drive shaft includingan engagement portion for engaging a hollow space of an intervertebralimplant in a form-fit connection, and a sleeve movably guiding the driveshaft and having a longitudinal axis.

An intervertebral implant which is configured to be engaged by aninsertion device for insertion of the implant between first and secondvertebral members is known from DE 10 2008 045 174 A1. Theintervertebral implant has an insertion opening including a slit-likeelongated shape that extends through the side wall. The insertionopening provides access to an inner space of the implant for theinsertion device. The insertion device has a sleeve and a shaft guidedthrough the sleeve, wherein an elongate support projection having acylindrical support surface is provided at a distal end of the shaft.

The shaft can be rotated with respect to the sleeve, such that theelongate support projection is first inserted through the slit-likeopening into the inner space and then rotated to establish a connection.The shaft may then be drawn back with respect to the sleeve in order toconnect the cylindrical support surface of the shaft with acorresponding cylindrical recess formed at an inner wall of the innerspace in a direction transverse to the insertion opening in a form-fitmanner. This connection allows for rotating and selectively positioningthe implant with respect to the insertion tool, wherein its shaftfollows the path of the slit-like opening. A counterforce and slidingengagement is achieved by an appropriately shaped front wall of thedistal end and of the sleeve, which engages the side wall of the implantaround the insertion opening.

Another insertion device, which has a shaft-like section that may berotated after insertion to establish a connection between the device andan intervertebral implant, is disclosed in US 2007/0162129 A1. At thedistal end of the shaft, an elongated head having a cuboid shape isprovided. Drawing back the distal end then sandwiches an outer wall ofthe implant between a back side surface of the cuboid-Ss shaped elongatehead and a stop provided at distal end of a sleeve-like first section ofthe device.

U.S. Pat. No. 8,673,012 B2 also discloses an intervertebral spacer whichin FIGS. 8A-C thereof has an inner cavity and a through hole, throughwhich a portion of an insertion tool having transverse extensions may beinserted and then rotated, to establish a connection between a trailingend of the intervertebral spacer and the insertion tool. Thereby, anappropriately shaped front wall of the insertion tool having engagementfeatures is pressed onto a side wall of the intervertebral spacer.

Documents EP 2 535 021 A1 and EP 2 535 022 A1 provide other examples ofdevices suitable for insertion of an intervertebral implant into a bodyfollowing transforaminal lumbar interbody fusion surgery techniques(TLIF). The TLIF technique involves approaching the spine from the sideof the spinal canal through a midline incision in the patients back.This approach greatly reduces the amount of surgical muscle dissectionand minimizes the nerve manipulation required to access the vertebrae,discs and nerves.

SUMMARY

According to aspects of embodiments of the invention, an intervertebralimplant and/or a device for inserting an intervertebral implant and/or asystem comprising an intervertebral implant and a device for insertingthe same that is simplified in terms of its use and in view of thepossibilities of final positioning are provided.

Aspects and features of embodiments of the invention, including anintervertebral implant, a device for inserting the intervertebralimplant into a body, and a system comprising the intervertebral implantand the device for inserting the same, are described herein with respectto some exemplary embodiments and are set forth in the claims.

According to one or more embodiments of the invention, an intervertebralimplant is provided wherein a sidewall connecting respective top andbottom surfaces includes a portion which is recessed or set back from anouter contour of the implant.

This recessed portion includes an elongate opening suited for insertionof an engagement portion of a drive shaft of an insertion tool into ahollow space provided within the implant. The outer contour of theimplant defines at least two guiding surfaces facing one another andconfigured for sliding engagement by a portion of a sleeve of theinsertion tool.

Thus, a connection between the implant of these embodiments and a devicefor insertion of the intervertebral implant into a body is improved inthat there is not or not only established a force acting onto the(recessed) side wall but (also) on one or more engagement surfacesfacing a recess. Hence, the guiding stability of the implant beingengaged by a respective insertion device is enhanced and failure of theconnection is avoided.

In one or more embodiments, the engagement surfaces are provided atextensions of the top and/or bottom surfaces, respectively, which extendbeyond an intersection of the recessed portion of the side wall and thetop and bottom surfaces, respectively. The outer edges of the extensionsform the outer contour of the implant at this location, from which therecessed portion is then set back to form a channel extending betweenthe extensions.

Embodiments of the implant may include a hollow space which is shaped toreceive an engagement portion of a drive shaft of an insertion tool in afirst state of insertion. The hollow space allows to establish aform-fit connection with a complementarily shaped engagement portion ofthe insertion device. In view of the form-fit connection no sandwichingor compression of a thin side wall between the engagement portion of thedrive shaft and a front wall or stop at the distal end of the sleeve isnecessary. This allows to define small dimensions of the hollow spacewithin the implant, for example only in a trailing end of the implant.

As a full form-fit connection is established between the hollow spaceand the engagement portion, further connection structures such as abovedescribed engagement surfaces may be specifically adapted to otherapplications than simple fixation of the implant. For example, guidingsurfaces may help in guiding and sliding engagement structures of thesleeve of an insertion tool. Alternatively or additionally, engagementstructures of the insertion device may be adapted to prevent removal ofthe engagement portion from the form-fit connection. Still further,engagement structures of the insertion device may be adapted to theguiding surfaces such as to improve handling of the implant by defininga single-sided rotation, as will be described below.

In one or more embodiments, the hollow space is spherical. When theengagement portion of the insertion tool is also at least partiallyspherical as well, a connection in the form of a ball joint isestablished.

Further, according to embodiments of the invention, a device forinserting an intervertebral implant into a body comprises a drive shaft,which includes an engagement portion for engaging a hollow space of anintervertebral implant, and a sleeve movably holding and guiding thedrive shaft and having a longitudinal axis. The sleeve comprises at afirst end thereof a first engagement structure, and adjacent the firstengagement structure a second engagement structure.

As in the embodiments above regarding the implant, the engagementportion of the insertion device may, for example, have a shapecorresponding to that of a hollow space to provide a form-fitconnection. Further, the shape of an engagement portion may be flattenedsuch as to allow passing the same through an elongate opening of theimplant prior to establishing the form-fit connection.

For example, if the engagement portion has a partially spherical shape,segments may be removed from a sphere on opposite sides thereof in orderto obtain two flat parallel planes on opposite sides of the sphere,which extend also parallel to the longitudinal axis of the sleeve of theinsertion device, which axis defines the direction of insertion. Boththe hollow space and the engagement portion have a simple structure, areeasy to manufacture, and provide a stable, large contact area form-fitconnection.

The first engagement structure of the sleeve may engage the at least oneguiding surface of the recessed portion of the side wall of theintervertebral implant as described above, when the engagement portionis received in the hollow space in a first state of insertion. Thereby,the first engagement structure is shaped to allow rotation of the sleeveand the drive shaft by an angle α about the longitudinal axis totransfer the engagement portion into a second state. In the second statethe engagement portion is supported in a form-fit connection in thehollow space.

The second engagement structure of the sleeve may engage the guidingsurfaces of the recessed portion, when the engagement portion issupported in the hollow space in the second state and the firstengagement structure is moved toward the recessed portion. Thereby,unlike the first engagement structure, the second engagement structureis shaped to prevent rotation of the sleeve and the drive shaft aboutthe longitudinal axis, thus defining a third state of connection.

Since there are two engagement structures positioned adjacent eachother, an adjustment of the guiding sleeve with respect to the driveshaft and implant allows to bring the engagement structures in contactwith the engagement surfaces of the implant in a sequential manner. Bothengagement structures differ from each other in that the firstengagement structure allows rotation of the sleeve while the secondengagement structure prevents rotation. In other words, the firstengagement structure allows establishing the form-fit connection byrotation, and the second engagement structure locks or secures theform-fit connection (the third or locked state).

In one embodiment, the third or locked state may be indicated to theoperator by a knob provided, for example, at the handle, which isindicative of the position of the sleeve with respect to the driveshaft, and thus with respect to the implant, which may be hidden insidethe body during surgery.

According to further embodiments, the rotation by the first engagementstructure may be limited by one or more stops to provide a single-sidedrotation only. This stop may define just one direction of rotation eachfor transferring the insertion tool from the first state into the secondstate and vice versa, respectively. A particular advantage arisesthereby in that the operator has to deal with only two different angularpositions of the instrument (rotated left and rotated right).

Hence, the angular position of the instrument as well as the position ofthe knob allow the operator to know in which of the three connectionstates the implant currently is (inserted, form-fit connected, orlocked).

According to one or more embodiments, the implant and the device areparticularly configured for a transforaminal lumbar interbody fusionsurgery (TLIF), the implant having a kidney-shape, a leading end and atrailing end, the hollow space, the elongate opening, and the recessedportion of the side wall as well as the engagement surfaces beingprovided at the trailing end.

In a second embodiment there is provided only one first engagementstructure at the sleeve thus facilitating a simple structure. Herein,rotation of the drive shaft with respect to the sleeve is permitted. Thefirst engagement structure may engage the guiding surfaces of theintervertebral implant, when the engagement portion is received in thehollow space in a first state of insertion. In this first state, thefirst engagement structure already prevents rotation of the sleeve withrespect to the implant. Next, the shaft is allowed to be rotated withrespect to the sleeve by an angle α about the longitudinal axis totransfer the engagement portion of the shaft into a second state. In thesecond state the engagement portion is supported in a form-fitconnection in the hollow space.

In the second embodiment, an outer contour of the implant in the regionof the guiding surfaces may define a rounded portion and a portionrecessed form the rounded shape, in particular a straight portion. Therecessed or straight portion allows a latched-in state of the implantwith respect to the device, which may correspond, for example, to aspecific posture of the implant maintained during insertion of theimplant towards the implant site. The latched-in state provides for arobust connection between the implant and the device and assists inmaintaining the posture until the implant reaches the implant site andalso provides a tactile response to the surgeon to indicate that theimplant is now urged to rotate at the first end of the device.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be best understood by the following detaileddescription of some embodiments taken in conjunction with theaccompanying drawings. Therein,

FIG. 1 shows in a perspective view an overview of an intervertebralimplant held by a device for inserting the implant into a body accordingto one or more embodiments of the invention;

FIG. 2A shows an enlarged perspective view of the intervertebral implantand a distal end portion of the device as shown in FIG. 1 in a stateprior to insertion;

FIG. 2B shows the same as FIG. 2A, but in a cross-sectional top view;

FIG. 3A shows in a perspective view a distal end portion of a driveshaft of the device shown in FIG. 2A in a first state of insertion(implant not shown);

FIG. 3B shows the same as FIG. 3A, but in a side view;

FIG. 3C shows the same as FIG. 3A, but rotated by 90° into a secondform-fit state (implant not shown);

FIG. 3D shows the same as FIG. 3C, but in a side view;

FIG. 3E shows the same as FIG. 3A, but in a front view from the distalside;

FIG. 4A shows in a top perspective view a distal end portion of aguiding sleeve of the device shown in FIG. 2A;

FIG. 4B shows the same as FIG. 4A, but in a side view;

FIG. 4C shows the same as FIG. 4A, but in a bottom perspective view;

FIG. 4D shows the same as FIG. 4C, but in a side view;

FIG. 4E shows the same as FIG. 4A, but in a front view from the distalside;

FIG. 5A shows the same as FIG. 5A, but in a first state of insertion ofthe drive shaft and engagement portion into the intervertebral implant;

FIG. 58 shows the same as FIG. 5A, but in a cross-sectional top view;

FIG. 6A shows the same as FIG. 5A, but after rotation of the drive shaftand engagement portion into a second state of a form-fit connectionbetween the implant and the device;

FIG. 6B shows the same as FIG. 6A, but in a cross-sectional top view;

FIG. 7A shows the same as FIG. 6A, but after drawing back the driveshaft to lock the form-fit connection between the implant and the devicein a third state;

FIG. 78 shows the same as FIG. 7A, but in a cross-sectional top view;

FIG. 8A shows in a perspective view the use of the intervertebralimplant and the distal end portion of the device firmly connected asshown in FIG. 7A in a state wherein the implant is rotated up to a leftside abutment between the drive shaft and the elongate opening;

FIG. 8B shows the same as FIG. 8A, but in a cross-sectional top view:

FIG. 9A shows in a perspective view the use of the intervertebralimplant and the distal end portion of the device firmly connected asshown in FIG. 7A in a state wherein the implant is rotated up to a rightside abutment between the drive shaft and the elongate opening;

FIG. 9B shows the same as FIG. 9A, but in a cross-sectional top view.

FIG. 10 shows in a perspective view an overview of an intervertebralimplant held by a device for inserting the Implant into a body accordingto second embodiments of the invention;

FIG. 11A shows an enlarged perspective view of the intervertebralimplant and a distal end portion of the device as shown in FIG. 10 in astate prior to insertion;

FIG. 118 shows the same as FIG. 11A, but in a cross-sectional top view;

FIG. 12A shows in a perspective view a distal end portion of a driveshaft of the device shown in FIG. 11A in a first state of insertion(implant not shown);

FIG. 12B shows the same as FIG. 12A, but in a side view;

FIG. 12C shows the same as FIG. 12A, but rotated by 90° into a secondform-fit state (implant not shown);

FIG. 12D shows the same as FIG. 12C, but in a side view;

FIG. 12E shows the same as FIG. 12A, but in a front view from the distalside:

FIG. 13A shows in a top perspective view a distal end portion of aguiding sleeve of the device shown in FIG. 11A;

FIG. 13B shows the same as FIG. 13A, but in a top view;

FIG. 13C shows the same as FIG. 13A, but viewed from a different angle;

FIG. 13D shows the same as FIG. 13A, but in a side view;

FIG. 13E shows the same as FIG. 13A, but in a front view from the distalside;

FIG. 14A shows the same as FIG. 11A, but in a first state of insertionof the drive shaft and engagement portion into the intervertebralimplant;

FIG. 14B shows the same as FIG. 14A, but in a cross-sectional top view;

FIG. 15A shows the same as FIG. 14A, but after rotation of the driveshaft and engagement portion into a second state of a form-fitconnection between the implant and the device;

FIG. 15B shows the same as FIG. 15A, but in a cross-sectional top view;

FIG. 16A shows the same as FIG. 15A, but after drawing back the driveshaft to lock the form-fit connection between the implant and the devicein a third state;

FIG. 16B shows the same as FIG. 18A, but in a cross-sectional top view;

FIG. 17A shows in a top view the use of the intervertebral implant andthe distal end portion of the device firmly connected as shown in FIG.16A in a state wherein the implant is rotated up to a left side abutmentbetween the drive shaft and the elongate opening;

FIG. 17B shows the same as FIG. 17A, but in a cross-sectional top view;

FIG. 18A shows in a top view the use of the intervertebral implant andthe distal end portion of the device firmly connected as shown in FIG.16A in a state wherein the implant is rotated up to a right sideabutment between the drive shaft and the elongate opening;

FIG. 18B shows the same as FIG. 18A, but in a cross-sectional top view.

DETAILED DESCRIPTION

Embodiments both of an intervertebral implant as well as of a device forinserting an intervertebral implant into a body are further detailedwith reference to FIGS. 1-9B. FIG. 1 shows in a perspective view anoverview of an intervertebral implant 1 held by a device 50 forinserting the implant into a body, or, more specifically, into a spacebetween two vertebrae of the vertebral column.

The device 50 includes a drive shaft 51 (see FIGS. 2A, 2B), a guidingsleeve 54, a handle 58, a resilient knob 59, and an adjusting means 60,which in an embodiment is an adjusting nut, which has an internal thread(not shown) that interacts with an external thread (not shown) at ornear the proximal end of the drive shaft 51. The drive shaft 51 ismovably guided within the sleeve 54 and can be advanced or retractedwith respect to the sleeve by rotating the adjusting nut of theadjusting means 60. Other means to facilitate advancement or retractionof the drive shaft 51 with respect to the guiding sleeve 54 may becontemplated as well, and the invention is not limited to the specificembodiment.

As can be seen particularly from FIGS. 3A through 3E, which show detailsof the distal end of drive shaft 51, the drive shaft 51 comprises anengagement portion 53 having a partially spherical shape (sphericalsurface 57), wherein on opposite aides thereof, segments of the sphereare removed to yield flat surfaces 61, 61′. The flat surfaces 61, 61′provide for a flattened shape of the engagement portion 63 which allowsintroduction of the same through a narrow elongate opening 8 of theimplant 1.

The engagement portion 53 is connected to a main portion 63 of the driveshaft 51 via a neck portion 62, which has a diameter smaller than adiameter of the main portion 63. However, the diameter of the neckportion 62, which in an embodiment is cylindrical, is substantially thesame as the width of the engagement portion 53 in a directionperpendicular to the opposite flat surfaces 61, 61′, as can be seen inFIG. 3B.

The drive shaft 51 further has adjacent the neck portion 62 and at anend of the main portion 63 two opposite protrusions 56, 56′ extendingperpendicular to a longitudinal axis of the drive shaft 51. One of theprotrusions (protrusion 58′) is as provided with a longitudinal groove52 extending along a portion of the drive shaft 51. The protrusions 56,56′ and the groove 52 interact with complementary features, such asrecesses 64, 64′ and a rib 55 provided in an inner bore 65 of theguiding sleeve 54 (see FIGS. 4A through 4E). As a result, the driveshaft 51 can be displaced with respect to the guiding sleeve 54 along alongitudinal axis L of the guiding sleeve 54 using the adjusting means60 as noted above, but cannot be rotated with respect to the guidingsleeve 54.

As can be seen from FIGS. 1, 2A and 2B, the intervertebral implant 1 issubstantially of a kidney shape and has a leading end 12 and a trailingend 13. The terms “leading” and “trailing” originate from the manner ofplacement Into the space between the vertebrae from a lateral side inthis specific embodiment (which refers to a TLIF cage). The implant 1has a top surface 2, a bottom surface 3, and a side wall 4 extendingbetween the top and bottom surfaces 2, 3. The top and bottom surfaces 2,3 are substantially planar and parallel to each other except inclinedportions 2 a, 2 b, and 3 b extending towards the leading end 12, whichfacilitates easier insertion between the vertebrae.

The side wall 4 comprises, in the example of the kidney-shaped TLIFcage, a cylindrical portion 4 a at the leading end 12, a concave portion4 b on a lateral side, a substantially cylindrical recessed portion 4 dat the trailing end 13, recessed transition portions 4 c on both sidesof the recessed portion 4 d, and a convex portion 4 e on the oppositelateral side.

The top surface 2 includes an edge with each of the portions 4 a, 4 band 4 e of the side wall 4 at the leading end 12 and the lateral sidesof the implant 1. However, at the trailing end 13, the top surface 2extends beyond the portions 4 c and 4 d of the side wall 4, which thusforms an overhanging extension 7 as can be seen in FIG. 2A. Similarly,the bottom surface 3 includes an edge with each of the portions 4 a, 4 band 4 e of the side wall 4 at the leading end 12 and the lateral sidesof the implant 1. At the trailing end 13, the bottom surface 3 extendsbeyond the portions 4 c and 4 d of the side wall 4, which thus forms anoverhanging extension 6 opposite the overhanging extension 7. As aresult, portions 4 c and 4 d of the side wall 4 are recessed or set backfrom an outer contour of the implant 1, which is defined by the edges ofthe top and bottom surfaces 2 and 3 in this example, including the edgesof the extensions 6 and 7.

As shown in FIG. 2A, the overhanging extensions 6 and 7 form surfaces16, 17, respectively, due to the set back of the portions 4 c, 4 d ofthe side wall 4. More specifically, surfaces 16, 17 extend around thetrailing end 13 in an arc-shaped manner and face towards each other withthe recessed portions 4 c, 4 d of the side wall 4 extendingtherebetween. Thus, a channel or recess is formed in the outer contourat the trailing end 13 of the implant 1 between extension 6, 7, which islimited by portions 4 c, 4 d of the side wall 4 and the surfaces 16, 17of the extensions 6, 7. Since the surfaces 16, 17 serve to guide andsupport engagement structures of the sleeve 54, as will be explainedbelow, the surfaces 16, 17 are denoted in the following as guidingsurfaces 16, 17. The guiding surfaces 16, 17 of the instant embodimentare parallel to each other, but may also be inclined or rounded.

As shown in FIG. 2A, an elongate opening 8 is formed within thecylindrically shaped recessed portion 4 d of the side wall 4. Theelongate opening has a horizontal length larger than its vertical heightand extends across the portion 4 d of the side wall 4 between a rightside end or stop 8 a and a left side end or stop 8 b along a directionsubstantially parallel to the plane of the top and bottom surfaces 2 and3.

The elongate opening 8 provides access to a hollow space 5 positionedadjacent the elongate opening 8 within the implant 1. The hollow space 5has a shape of a sphere 5 b. Moreover, the hollow space 5 has a diameterwhich is larger than the vertical height of the elongate opening 8. Thehollow space 5 may, for example, be manufactured by furnishing acylindrical core bore hole 5 a first in the solid material within theimplant 1, and then skimming the sphere 5 b in a second step, therebyexpanding the core bore hole 5 a at an appropriate position adjacent theelongate opening 8 along the core bore hole 5 a to the shape of thesphere 56, as can be seen in FIG. 2B. However, other manufacturingtechniques of the implant such as rapid prototyping, mechanical or lasercutting, etc. are possible as well.

As can be seen particularly in the top view of FIG. 2B, the hollow space5 has a symmetrical center point M of the sphere 5 b, and the portion 4d of the side wall 4 as well as the guiding surfaces 16, 17 (in FIG. 2B,only the surface 16 is shown) are concentric about an axis A extendingthrough the center point M. The axis A extends vertically through theimplant through the center point M, and represents a rotation axis ofthe implant 1 with respect to the device 50. As will be described below,the recessed portion 4 d and the guiding surfaces 16, 17 are engaged bythe engagement structures 70, 80 provided at a distal end of the sleeve54 when a connection is established between the device 50 and theimplant 1 as shown in FIG. 1. The engagement may be a sliding engagementto allow for rotation and a range of angular positions of the implant 1with respect to the device 50. Moreover, the guiding surfaces 16, 17help in firmly supporting the engagement structures 70, 80 afterengagement.

Returning to the description of the device 50, FIGS. 4A through 4Edepict details of the engagement structures 70, 80 of the guiding sleeve54. More specifically, the sleeve 54 is provided with a first engagementstructure 70 and also with a second engagement structure 80 positionedadjacent each other at the distal end of the sleeve 54. In operation ofthe device 50 and implant 1, the first engagement structure 70 engageswith the guiding surfaces 16, 17 in a first state of insertionillustrated in FIGS. 5A and 58 and in a second state, wherein a form-fitconnection has been established as illustrated in FIGS. 6A and 6B, andthe second engagement structure 80 engages with the guiding surfaces 16,17 in a third state illustrated in FIGS. 7A and 7B, wherein the form-fitconnection is secured or locked.

The first engagement structure 70 comprises a front wall 71 configuredto be brought into contact with the recessed portion 4 d of the sidewall 4. The front wall 71 for this purpose has a complementary shapewith respect to the recessed portion 4 d, i.e., cylindrical in thisembodiment.

The first engagement structure 70 further has two opposite outer roundedguiding faces 72, 72′ each shaped as a segment of a cylinder. Outerrounded guiding faces 72, 72′ extend about a quarter circle around thelongitudinal axis L of the sleeve 54 and define a diameter which issubstantially equal to the distance between the guiding surfaces 16, 17of the implant 1. Accordingly, the first engagement structure 70 and theouter rounded guiding faces 72, 72′ may be inserted into the channeldefined between the guiding surfaces 16, 17 of implant 1.

The first engagement structure 70 further has two opposite stops or stopfaces 73, 73′ which are continuous with the outer rounded guiding faces72, 72′ but deviate from a cylinder shape towards larger radii. The stopfaces 73, 73′ in this embodiment correspond to parts of a cuboid shape.When seen from the front side, the stop faces 73, 73′ provide a squareprofile while the rounded guiding faces 72, 72′ provide a circularprofile. As a result, a diameter between portions of the opposite stopfaces 73, 73′ extending through the longitudinal axis L is larger thanthe distance between the opposite guiding surfaces 16, 17 of the implant1.

FIGS. 5A and 58 depict a first state after performing a step ofinserting (see arrow 101 in FIG. 5A) the engagement portion 53 of thedrive shaft 51 through the elongate opening 8 into the hollow space 5with the flat surfaces 61 of the engagement portion 53 being held in ahorizontal posture (see FIG. 2A). In this first state, the engagementportion 53 and the neck portion 62 at the distal end of the drive shaft51 project from the open distal end of the bore 65 of the sleeve 54 by apredetermined distance, such that when the engagement portion 53 abutsat the back surface of hollow space 5 in order to be fully receivedtherein after insertion, the outer rounded guiding faces 72, 72′ engagewith the guiding surfaces 16, 17 of implant 1. In this posture, the stopfaces 73, 73′ only abut on the guiding surfaces 16, 17, respectively.

As a result, the guiding sleeve 54 can be rotated with respect to theguiding surfaces 16, 17 only in one direction, while the stop faces 73,73′, due to the abutment and larger diameter, impede rotation in theother direction.

FIGS. 6A and 6B depict a second state after performing a step ofrotating (see arrow 102 in FIG. 6A) the guiding sleeve 54 along with thedrive shaft 51 held therein by an angle α of 90° in the clockwisedirection about the longitudinal axis L. The engagement portion 53 hasnow been brought into a form-fit connection with the hollow space 5 inview of the respective complementary shapes. The flat surfaces 61 of theengagement portion 53 are perpendicular to the elongate opening 8 andthus, the engagement portion 53 cannot be removed from the hollow space5 in the rotated posture.

Also, while the rounded guiding faces 72, 72′ allow sliding rotation ofthe sleeve 54 with respect to the guiding surfaces 16, 17, havingrotated the sleeve 54 by about a quarter circle (i.e., α=90°), the stopfaces 73, 73′ again abut on the guiding surfaces 16, 17 to impedefurther rotation of the sleeve 54. This stop and end point of rotationprovides the operator with a clear indication that a form-fit connectionhas been established. Also, in case that removal of the device 50 fromthe implant 1 is intended, for example when the implant 1 has beenplaced between two vertebrae, there is only one possibility of rotatingback the sleeve 54 into the other direction (counterclockwise) by anangle α of 90°. This allows the operator to accurately control thehandling of the device 50 and implant 1 under conditions of limitedvisibility.

FIGS. 7A and 7B depict a third state after performing a step ofretracting the drive shaft 51 (see arrow 103) with respect to theguiding sleeve 54 by a predetermined distance using, for example, theadjustment nut 60 shown in FIG. 1. In this embodiment, the neck portion62 is almost retracted within the bore 65 of the sleeve 54. Since theengagement portion 53 is firmly held in view of the form-fit connectionwith the hollow space 5, the sleeve 54 is thus drawn and moved towardthe implant 1. More specifically, the front wall 71 of the firstengagement structure 70 is brought in contact with the recessed portion4 d of the side wall 4 of the implant 1. Also, the rounded guiding faces72, 72′ and the abutment faces of the stops 73, 73′ slide inwards at theguiding surfaces 16, 17.

As a result, flat faces 81 provided with respect to the secondengagement structure 80, which are continuous with the abutment faces ofthe stops 73, 73′ are brought into engagement with the guiding surfaces16, 17 of the implant 1. However, since the second engagement structure80 fails to have rounded guiding faces having a diameter equal to thedistance between the guiding surfaces 16, 17, the guiding sleeve 54 canno more be rotated in this third state about its longitudinal axis L.Consequently, the form-fit connection between the engagement portion 53and the hollow space 5 is locked or secured.

The knob 59 shown in FIG. 1 may be configured to interact with, forexample, a protrusion or groove at the drive shaft 51 to provide atactile response to the operator indicating that the drive shaft 51 hasbeen retracted by a correct amount of distance such that the front wallmay slide on the recessed portion 4 d of the side wall 4 with lessfriction. Further retraction may serve to releasably fix a desiredangular position between the device 50 and the implant 1, if necessary.

FIGS. 8A and 88 depict a state of the implant 1 in which the angularposition is changed from that shown in FIGS. 7A and 7B by sliding theengagement structures 70, 80 of the sleeve along the recessed portion 4d and the guiding surfaces 16, 17, respectively, leftward until aportion of the neck portion 62 still protruding from the sleeve 54 abutson a left-side stop face 8 b of the elongate opening 8.

Similarly, FIGS. 9A and 9B depict a state of the implant 1 in which theangular position is changed from that shown in FIGS. 7A and 7B bysliding the engagement structures 70, 80 of the sleeve along therecessed portion 4 d and the guiding surfaces 16, 17, respectively,rightward until a portion of the neck portion 62 still protruding fromthe sleeve 54 abuts on a right-side stop face 8 a of the elongateopening 8.

Using the steps as outlined above, a placement of the implant 1according to the embodiment between two vertebrae may be performed usingthe device 50 for inserting the implant in a method as illustrated, forexample, in FIGS. 9a ) through 9 f) of document EP 2 535 022 A1, whichis in this regard Incorporated herein by reference, wherein implant 1and device 20 of that document are replaced with the implant 1 and thedevice 50 of the present embodiment.

Next, second embodiments both of an intervertebral implant as well as ofa device, respectively, for inserting an intervertebral implant into abody are explained with reference to FIGS. 10-18B. The overall structureof the implant of this second embodiment is similar to that of the firstembodiment and repeated discussion of similar features will be omittedin the following. One difference between the embodiments of the systemcan be seen in that only a first engagement structure 180 is provided atthe device in the second embodiment, but a second engagement structureis omitted herein. In the first embodiment, the engagement structure 70allows for a joint rotation of the guiding sleeve and the drive shaftwith respect to the implant in order to establish the form-fitconnection. In the second embodiment, as will be described below, arotation of the drive shaft with respect to the guiding sleeve isallowed such that a more simple sleeve design may be provided. FIG. 10shows in a perspective view an overview of an intervertebral implant 101held by such a device 150 for inserting the implant into a space betweentwo vertebrae of the vertebral column.

The device 150 comprises a drive shaft 151 (see FIGS. 11A, 11B), aguiding sleeve 154, a handle 158, a turning handle 159 and an adjustingmeans 160, which may be an adjusting nut similar to the adjusting means60 of the first embodiment, and which similarly interacts with the driveshaft 151 via threads. The drive shaft 151 is movably guided within thesleeve 154 and can be advanced or retracted with respect to the sleeve154 by actuating the adjusting means 160. Other means to facilitateadvancement or retraction of the drive shaft 151 with respect to theguiding sleeve 154 may be contemplated as well, and the invention is notlimited to a specific embodiment. The turning handle 159 permitsrotation of the drive shaft 151 with respect to the guiding sleeve 154.

FIGS. 12A through 12E show details of the distal end of drive shaft 151.The drive shaft 151 comprises an engagement portion 153 having aspherical segment-shaped surface 157, wherein flat or planar surfaces161, 161′ are provided on opposite sides thereof as in the firstembodiment. Position marks 269 are provided on one or both of the flatsurfaces 161, 161′ in the form of a strip. The strip indicates to theoperator an orientation of the engagement portion 153 within the hollowspace as will be explained below.

The engagement portion 153 is also connected to a main portion 163 ofthe drive shaft 151 via a neck portion 162, which has a diameter smallerthan a diameter of the main portion 163 as well as of the engagementportion 153, when the spherical segment-shaped surface 157 isconsidered, similar to the first embodiment. However, the diameter ofthe neck portion 162 is substantially the same as the width of theengagement portion 153 in a direction perpendicular to the opposite flatsurfaces 161, 161′, as can directly be seen in FIG. 12B. The mainportion 163 has a cylindrical shape which in this embodiment allows thedrive shaft 151 to be rotated with respect to the guiding sleeve 154.

Similar to the first embodiment, the intervertebral implant 101 of thesecond embodiment is also substantially of a kidney shape including aleading end 12 and a trailing end 13, a top surface 102, a bottomsurface 103, and a side wall 104 extending between the top and bottomsurfaces 102, 103. The top and bottom surfaces 102, 103 aresubstantially planar and parallel to each other except an inclinedportion 102 a, which extends towards the leading end 12.

The sidewall 104 has a rounded portion 104 a at the leading end 12, aconcave portion 104 b on a lateral side, a recessed portion 104 d formedby inwardly extending wall portions at the trailing end 13 which will beexplained in more detail below, and a convex portion 104 e on theopposite lateral side

The top surface 102 as well as the bottom surface 103 each form an edgewith each of the portions 104 a, 104 b and 104 e of the side wall 104 atthe leading end 12 and the lateral sides of the implant 101. At thetrailing end 13, the top surface 102 extends beyond the inwardlyextending wall portions which form the recessed portion 104 d of theside wall 104. As a result, overhanging extensions 106, 107 are formedas shown in FIG. 11A. An outer contour of the implant 101 may be definedby the edges of the top and bottom surfaces 102 and 103 in this exampleincluding the edges of the extensions 106 and 107.

Substantially planar surfaces 116, 117 are provided by these extensions106 and 107, respectively, due to the presence of the recessed portion104 d of the side wall 104. The surfaces 116, 117 extend along or aroundthe trailing end 13 in an arc-shaped manner and face towards each otherwith the recessed portion 104 d extending therebetween. Thus, a recessis formed in the outer contour at the trailing end 13 of the implant101, which is limited by the recessed portion 104 d of the side wall 104and the surfaces 116, 117 of the extensions 106, 107. As in the firstembodiment, the surfaces 116, 117 may be denoted as guiding surfaces. Inan embodiment, the guiding surfaces 116, 117 of the second embodimentare parallel to each other, but may also be inclined or rounded.

A hollow space 105 is provided within the implant 101 as can best beseen in FIGS. 11A and 118 and has a shape of a sphere or sphericalsegment. The hollow space 105 of the second embodiment is formed by eachof spherical segments 105 b provided within extensions 106, 107 andfacing each other, and by a spherical wall portion 105 d which is inthis example continuous with the inwardly extending wall portions of therecessed portion 4 d. The hollow space 105 is open towards the outside.The inwardly extending wall portions of the recessed portion 104 d forman elongate opening 108, which thus extends through the recessed portion104 d and provides access to the hollow space 105. The elongate opening108 has a horizontal length larger than its vertical height and extendsacross the recessed portion 104 d between respective wall portionsprovided as right side stops and left side stops along a directionsubstantially parallel to the plane of the top and bottom surfaces 102and 103.

The hollow space 105 has a diameter which is larger than the verticalheight of the elongate opening 108, i.e., larger than a distance betweenthe guiding surfaces 116, 117. In this embodiment, the diameter issufficiently large such that a circular hole 105 c is created in each ofthe top surface 102 and the bottom surface 103. The circular holes 105 callow an operator to inspect an orientation of the engagement portions153 of the drive shaft 151 when being received in the hollow space 105.The diameter of the hollow space 105 is the same or slightly larger thana diameter of the engagement portion 153 to permit receiving, rotatingand supporting the engagement portion 153 therein. Further, in thisembodiment, a distance between the guiding surfaces 116, 117 is the sameas or slightly larger than a distance between the flat or planarsurfaces 161, 161′ of the engagement portion 153 to allow insertion ofthe engagement portion 153 into the elongate opening 108 in a horizontalposture. The hollow space 105 may be manufactured as in the firstembodiment, for example by furnishing a cylindrical core bore hole 105 afirst, etc.

Moreover, the hollow space 105 has a symmetrical center point M definedby the spherical segment-shaped surfaces 105 b, 105 d. Further, theguiding surfaces 116, 117 are concentric about an axis A extendingthrough the center point M, which extends vertically (perpendicular tothe plane of surfaces 102, 103) through the implant. Axis A represents arotation axis of the implant 101 with respect to the device 150. Theguiding surfaces 116, 117 are engaged by an engagement structure 180provided at a distal end face of the guiding sleeve 154 when aconnection is established between the device 150 and the implant 101 asshown in FIG. 10. Also, when the engagement portion 153 is supported inthe hollow space 105, the neck portion 162 having the diameter which isthe same as the distance between the flat or planar surfaces 161, 161′of the engagement portion 153 is thus also sandwiched and slideablyguided between the guiding surfaces 116, 117 which further increases thestability and robustness of the system during engagement.

The guiding sleeve 154 and the engagement structure 180 are explainedwith reference to FIGS. 13A through 13E. As can be seen, the sleeve 154is provided with a first engagement structure 180 in the form of twoprojections 180 a having a cylindrical-segment-shape and extending in adistal direction from the distal end face. The distal end face has asubstantially annular shape and comprises a concave portion 171 a and aplanar portion 171 b. The two projections 180 a each extend from theplanar portion 171 b and are located diametrically opposite to eachother. An inner wall of each of the projections 180 a is continuous witha surface of an inner bore 165 of the sleeve 154. Thus the twoprojections 180 a also extend in a circumferential direction around theinner bore 165 between respective end faces thereof. These end faces inthis embodiment have a planar shape and are parallel to each other.These end faces form guiding faces 181 configured for sliding engagementwith the guiding surfaces 116, 117 of the implant. The distance betweeneach two guiding faces 181 of one projection 180 a is the same orslightly less than a distance between the guiding surfaces 116, 117 ofthe implant 101. As a result. In an attached state of the device 150 andthe implant 101 the projections 180 a are sandwiched between the guidingsurfaces 116, 117 with the guiding faces 181 being in slidingengagement.

The concave portion 171 a is positioned between the projections 180 a ina circumferential direction and has a curvature which corresponds tothat of the arc shaped outer contour of extensions 106, 107 to allowsliding and/or tight locking upon actuation of the adjusting means 160.It is noted that according to further modifications, the portions 171 amay also be planar. Further, the guiding faces 181 may also have roundedshape and may be inclined with respect to each other and with respect tothe guiding surfaces of the implant when the device is attached.Further, the sleeve 154 may have a flattened portion 257 extending fromthe concave portion 171 a of the distal end face along an outer surfaceof the sleeve and a portion 258 extending from the planar portion 171 bin a similar manner. The flattened portions facilitate gripping (portion157) or receiving a position mark 259 provided as a strip.

Operation of the device 150 and implant 101 is explained with referenceto FIGS. 14A through 188. Different from the first embodiment, uponinserting the drive shaft 151 into the implant 101 according to thesecond embodiment, the first engagement structure 180 engages with theguiding surfaces 116, 117 in all states of the attachment process, i.e.,in a first state of insertion of the engagement portion 153 into thehollow space 105 illustrated in FIGS. 14A and 14B, in a second statewherein a form-fit connection has been established as illustrated inFIGS. 15A and 15B, and in a third state wherein a connection is lockedby drawing back the drive shaft 151 supporting the implant and therebypressing the concave portion 171 a of the sleeve 154 in the oppositedirection against the outer contour of the extensions 106, 107.

More specifically, FIGS. 14A and 14B depict a first state afterperforming a step of inserting (see arrow 301 in FIG. 14A) theengagement portion 153 of the drive shaft 151 through the elongateopening 108 into the hollow space 105. As in the first embodiment theflat surfaces 161 of the engagement portion 153 are held in a horizontalposture (FIG. 11A or 12A). Thereby, the engagement portion 153 and theneck portion 162 at the distal end of the drive shaft 151 project fromthe open distal end of the inner bore 165 of the sleeve 154 by apredetermined distance, such that when the engagement portion 153 abutsat the back surface of the hollow space 105, the projections 180 a ofengagement structure 180 enter the channel or elongate opening 108. As aresult, the guiding faces 181 at the projections 180 a engage with theguiding surfaces 116, 117 of implant 101. Also, the arrangement of thetwo guiding faces 181 on either side of the sleeve 154 prevents anyrotation of the sleeve 154 around its longitudinal direction L.Moreover, the concave portions 171 a of the distal end surface of theguiding sleeve 154 abut on the arc-shaped outer contour of the implant101 in a region of the extensions 106, 107, which includes thecorresponding curvature. In this posture shown in FIG. 14A, the positionmark 269 of the drive shaft 151 is still aligned (see FIG. 11A) with theposition mark 259 at the sleeve, and is visible through the circularhole 105 c.

FIGS. 15A and 15B depict a second state after performing a step ofrotating the drive shaft 151 (see arrow 302 in FIG. 15A, the drive shaftis indicated with dotted lines) by an angle α of 90° in the clockwisedirection about the longitudinal axis L with respect to the guidingsleeve 154. This rotation may be effected by actuating the turninghandle 159 provided at the handle 158 as shown in FIG. 10. Theengagement portion 153 is thereby transferred into a form-fit connectionwith the hollow space 105. Like in the first embodiment, the engagementportion 153 cannot be removed from the hollow space 105 in the rotatedposture. Meanwhile, the position mark 269 disappeared from the circularhole 105 c due to the rotation of the drive shaft 151.

FIGS. 16A and 16B depict a third state after performing a step ofdrawing back the drive shaft 151 (see arrow 303) with respect to theguiding sleeve 154 using, for example, the adjustment nut 160 shown inFIG. 10. Thereby, the sleeve 154 is urged in the distal direction andpressed via concave portion 171 a against the outer contour of theextensions 106, 107, while the drive shaft 151 is drawn back into theproximal direction with the implant 101 held in the form-fit connection.Unlike the first embodiment, the mutual displacement between the driveshaft 151 and the guiding sleeve 154 is small, and no further engagementportion is introduced into the channel of the implant 101 between theguiding surfaces 116 and 117. The instant step of drawing back the driveshaft 151 with respect to the sleeve 154 thus only serves to fix or lockan angular position of the implant 101 with respect to the device 151,or to adjust the amount of friction between the guiding faces andsurfaces.

FIGS. 17A and 178 depict a state of the implant 101 in which the angularposition is changed from that shown in FIGS. 16A and 16B by sliding theengagement structure 180 of the guiding sleeve along the outer contourof the extensions 106, 107 and the guiding surfaces 116, 117, leftward(indicated by the arrows) until one of the projections 180 a of thesleeve 154 abuts on a left-side inwardly extending wall portion of therecessed portion 104 d, or elongate opening 108, respectively. Therotation of the implant 101 is around axis A extending through thecenter point M of the hollow space 105. Herein, the concave portion 171a of the distal end face of the sleeve 154 abuts against and slides withrespect to the arc-shaped or curved portion 106 a of the outer contourof extensions 106, 107. The curvatures correspond to each other suchthat a smoothly guided sliding contact at a constant radial distancefrom center point M of the hollow space 105 is achieved.

Similarly, FIGS. 18A and 18B depict a state of the implant 101 in whichthe angular position is changed from that shown in FIGS. 16A and 16B bysliding the engagement structure 180 of the guiding sleeve 154 along theouter contour of the extensions 106, 107 and the guiding surfaces 116,117 rightward (see arrows in FIGS. 18A, 18B) until the other one of theprojections 180 a of the sleeve 154 abuts on a right-side inwardlyextending wall portion of the recessed portion 104 d, or elongateopening 108, respectively. As noted above, the rotation of the implant101 is around axis A. Herein, the planar portion 171 b of the distal endface of the guiding sleeve 154 abuts against and slides with respect tothe correspondingly shaped straight portion 106 b of the outer contourof extensions 106, 107 which is recessed from curved portion 106 a withregard to a radial distance from the center point M. If a slightpressure force exerted on the sleeve in a distal direction is maintainedthroughout rotation of the implant 101 around axis A, the sleeve thuslatches-in, when reaching the position shown in FIGS. 18A and 18B. Thelatched-in state provides for a particular robust connection between theimplant and the device during transfer to the implant site.

Various modifications of the implant and/or the device may be madewithout departing from the scope of the invention as defined in theappended claims.

Namely, the implant shown in the above described embodiment is only anexample. The contour and shape of the implant may be different accordingto the specific clinical requirements. For example, the contour may haveany other shape, such as circular, rectangular, oval, etc. In someembodiments, the height of the side wall may be constant throughout theimplant.

Moreover, the elongate opening can be at another position. Stillfurther, the elongate opening may extend vertically or in an inclinedposture. Also, only one opening or more than one opening may beprovided. Also, it may be possible to adapt existing intervertebralimplants without an opening, by providing it with such an opening asproposed herein.

According to further modifications, the recessed portions 4 c and/or 4 dof the side wall 4, and/or the front wall 71 of the sleeve 54, may beprovided with ratcheting features, or teeth or ribs and grooves, orroughened surfaces to increase a clamping force, when brought intocontact with each other. Alternatively, the surface may be coated toincrease friction.

In the above embodiments, the drive shaft 51 may be rotated by an angleα of about 90°. However, other ranges of rotation are possible as well.Also, when the respective stops 73, 73′ having abutment faces areprovided to define end points of rotation, releasable snap-in means maybe provided to provide a tactile response to the operator, that adesired state has been reached with respect to the engagement portion53.

Similarly, when the second embodiment is concerned, stops defining endpoints may be provided with regard to the rotation of the drive shaftwithin the sleeve.

The implant is made of a biocompatible material. For example, theimplant can be made of stainless steel or titanium, or of abiocompatible metal alloy, such as a nickel titanium alloy, for exampleNitinol, or can be made of a biocompatible plastic material, forexample, PEEK (polyetheretherketone).

Alternative aspects of the invention may also be contemplated, whereinthe portion of the side wall, which includes the elongate opening, maynot be recessed or set back from an outer contour.

In one or more embodiments, an intervertebral Implant having the hollowspace 5 formed within the implant and accessible through the elongateopening 8 extending through the recessed portion 4 d of the side wall 4is provided, wherein the hollow space 5 is shaped to receive theengagement portion 53 of the drive shaft 51 of the device 50 forinsertion of an implant; wherein the hollow space 5 is shaped to receivethe engagement portion 53 of the drive shaft 51 of the insertion tool 50in a first state of insertion, and to support the engagement portion 53in a second state in a form-fit connection, in which the engagementportion 53 is rotated from the first state by an angle α. The hollowspace may have a spherical shape.

In a specific aspect, an intervertebral implant having the hollow space5 formed within the Implant and accessible through the elongate opening8 extending through the recessed portion 4 d of the side wall 4 isprovided, wherein the hollow space 5 is shaped to receive the engagementportion 53 of the drive shaft 51 of the device 50 for insertion of animplant; wherein the hollow space 5 has a spherical shape.

Alternative aspects of the invention may also be contemplated, whereinthe first engagement structure or the second engagement structure isomitted, respectively, and only one of the engagement structures isimplemented, while the other features may be the same as defined in theappended claims.

1.-16. (canceled)
 17. An intervertebral implant comprising a topsurface, a bottom surface, and a side wall extending between the topsurface and the bottom surface, the intervertebral implant having ahollow space formed within the intervertebral implant and accessiblethrough an elongate opening extending through a recessed portion of theside wall, wherein the hollow space has a spherical segment shape toreceive an engagement portion of a drive shaft of a device for insertionof an implant, and wherein the intervertebral implant further comprisesat least two guiding surfaces extending along an end of theintervertebral implant in an arc-shaped manner and facing one anothersuch that the recessed portion of the side wall extends therebetween,the at least two guiding surfaces being configured for slidingengagement by a portion of a sleeve of a device for insertion of animplant.
 18. The intervertebral implant of claim 17, wherein therecessed portion is set back from an outer contour of the intervertebralimplant such as to provide the at least two guiding surfaces.
 19. Theintervertebral implant according to claim 17, wherein, at the locationof the recessed portion of the side wall, an outer contour of theintervertebral implant is provided by an extension of the top surfaceand an extension of the bottom surface, each extending beyond therecessed portion of the side wall.
 20. The intervertebral implantaccording to claim 19, wherein the hollow space has a center point,wherein each of the extensions comprises a respective one of the atleast two guiding surfaces, wherein each of the at least two guidingsurfaces is concentric about a longitudinal axis extending through thecenter point.
 21. The intervertebral implant according to claim 17,wherein the hollow space has a center point, wherein the recessedportion of the side wall is arranged to be concentric about alongitudinal axis extending through the center point.
 22. Theintervertebral implant according to claim 21, wherein the recessedportion of the side wall has a cylindrical shape or a spherical shape.23. The intervertebral implant according to claim 17, wherein theintervertebral implant is a transforaminal lumbar interbody fusion(TLIF) implant having a kidney-shape, and including a leading end and atrailing end, wherein the hollow space, the recessed portion of the sidewall, and the elongate opening are provided at or adjacent the trailingend.
 24. An intervertebral implant comprising a top surface, a bottomsurface, and a side wall extending between the top surface and thebottom surface, the intervertebral implant having a hollow space formedwithin the intervertebral implant and accessible through an elongateopening extending through the side wall at an end of the intervertebralimplant, wherein the hollow space has a spherical segment shape toreceive an engagement portion of a drive shaft of a device for insertionof an implant, and wherein the intervertebral implant further comprisesat least two guiding surfaces extending along the end of theintervertebral implant in an arc-shaped manner and facing one another,the at least two guiding surfaces being configured for slidingengagement by a portion of a sleeve of a device for insertion of animplant.
 25. The intervertebral implant according to claim 24, wherein,at a location of the side wall at the end of the intervertebral implant,an outer contour of the intervertebral implant is provided by anextension of the top surface and an extension of the bottom surface,each of the extensions comprising a respective one of the at least twoguiding surfaces.
 26. The intervertebral implant according to claim 25,wherein the hollow space has a center point, and the outer contour ateach of the extensions is concentric about a longitudinal axis extendingthrough the center point.
 27. The intervertebral implant according toclaim 25, wherein each of the extensions extends beyond a recessedportion of the side wall.
 28. An intervertebral implant comprising a topsurface, a bottom surface, and a side wall extending between the topsurface and the bottom surface, the intervertebral implant having ahollow space formed within the intervertebral implant and accessiblethrough an elongate opening extending through the side wall, wherein thehollow space has a spherical segment shape to receive an engagementportion of a drive shaft of a device for insertion of an implant,wherein a recessed portion of the side wall is defined by wall portionsextending inwardly from an outer contour of the intervertebral implantto the hollow space, and the elongate opening extends between the wallportions, and wherein the intervertebral implant further comprises atleast two guiding surfaces extend along an end of the intervertebralimplant in an arc-shaped manner and face one another such that theelongate opening extends therebetween, the at least two guiding surfacesbeing configured for sliding engagement by a portion of a sleeve of adevice for insertion of an implant.
 29. The intervertebral implantaccording to claim 28, wherein the hollow space has a center point, andwherein each of the at least two guiding surfaces includes a firstportion at which the outer contour is concentric about a longitudinalaxis extending through the center point, and each of the at least twoguiding surfaces further includes a second portion at which the outercontour is recessed from a concentric shape about the longitudinal axis,such that a radial distance from the outer contour at the second portionto the longitudinal axis is less than a radial distance from the outercontour at the first portion to the longitudinal axis.
 30. Theintervertebral implant according to claim 29, wherein at the secondportion, the outer contour extends in a straight direction.
 31. Theintervertebral implant according to claim 28, wherein at least one ofthe top surface or the bottom surface has a hole to allow visual accessto the hollow space.
 32. A system comprising an intervertebral implantand a device to insert the intervertebral implant into a body, theintervertebral implant comprising a top surface, a bottom surface, and aside wall extending between the top surface and the bottom surface, theintervertebral implant having a hollow space having a spherical segmentshape formed within the intervertebral implant and accessible through anelongate opening extending through a recessed portion of the side wall,and at least two guiding surfaces extending along an end of theintervertebral implant in an arc-shaped manner and facing one anothersuch that the recessed portion of the side wall extends therebetween,wherein the device comprises: a drive shaft including an engagementportion configured to engage the intervertebral implant in the hollowspace; and a sleeve movably holding and guiding the drive shaft andhaving a longitudinal axis, wherein the sleeve comprises an engagementstructure configured to engage and slide along the at least two guidingsurfaces and shaped to prevent rotation of the sleeve relative to the atleast two guiding surfaces about the longitudinal axis, when theengagement portion is received in the hollow space through the elongateopening and rotated by an angle about the longitudinal axis such thatthe engagement portion is supported in the hollow space.
 33. The systemaccording to claim 32, wherein the sleeve further comprises anotherengagement structure adjacent the engagement structure and including aguiding face configured to engage one of the at least two guidingsurfaces, wherein the guiding face has a rotational symmetry about thelongitudinal axis of the sleeve to allow rotation of the sleeve withrespect to the one of the at least two guiding surfaces.
 34. The systemaccording to claim 33, wherein the another engagement structure includesat least one stop configured to limit a rotation of the sleeve withrespect to the at least two guiding surfaces, to each define only onedirection of rotation for transferring the engagement portion of thedevice from a first state into a second state and vice versa,respectively.
 35. The system according to claim 32, wherein the driveshaft and the sleeve each comprises a guiding structure configured tolimit a movement of the drive shaft to that in a direction along thelongitudinal axis, but prevent a rotation of the drive shaft withrespect to the sleeve.
 36. The system according to claim 32, furthercomprising an adjusting device configured to adjust a position of thedrive shaft with respect to the sleeve along the longitudinal axis. 37.The system according to claim 32, further comprising a resilient knobcooperating with the drive shaft and being indicative of a position ofthe drive shaft with respect to the sleeve along the longitudinal axis,in which the engagement structure engages the at least two guidingsurfaces.
 38. A system comprising an intervertebral implant and a deviceto insert the intervertebral implant into a body, the intervertebralimplant comprising a top surface, a bottom surface, and a side wallextending between the top surface and the bottom surface, theintervertebral implant having a hollow space having a spherical segmentshape formed within the intervertebral implant and accessible through anelongate opening extending through the side wall at an end of theintervertebral implant, the intervertebral implant further comprising atleast two guiding surfaces extending along the end of the intervertebralimplant in an arc-shaped manner and facing one another, wherein thedevice comprises: a drive shaft including an engagement portionconfigured to engage the intervertebral implant in the hollow space; anda sleeve movably holding and guiding the drive shaft and having alongitudinal axis, wherein the sleeve comprises an engagement structureconfigured to engage and slide along the at least two guiding surfacesand shaped to prevent rotation of the sleeve relative to the at leasttwo guiding surfaces about the longitudinal axis, when the engagementportion is received in the hollow space through the elongate opening androtated by an angle about the longitudinal axis such that the engagementportion is supported in the hollow space.
 39. The system according toclaim 38, wherein, at a location of the side wall at the end of theintervertebral implant, an outer contour of the intervertebral implantis provided by an extension of the top surface and an extension of thebottom surface, each of the extensions comprising a respective one ofthe at least two guiding surfaces.
 40. The system according to claim 39,wherein each of the extensions extends beyond a recessed portion of theside wall.
 41. The system according to claim 38, wherein the engagementportion of the drive shaft has a spherical shape flattened on oppositesides thereof.
 42. The system according to claim 38, wherein the deviceis configured to rotate the intervertebral implant about a symmetricalcenter point of the hollow space via the drive shaft which may follow apath of the elongate opening of the intervertebral implant, and/or viathe engagement structure sliding along a path defined by the at leasttwo guiding surfaces.
 43. A system comprising an intervertebral implantand a device to insert the intervertebral implant into a body, theintervertebral implant comprising a top surface, a bottom surface, and aside wall extending between the top surface and the bottom surface, theintervertebral implant having a hollow space having a spherical segmentshape formed within the intervertebral implant and accessible through anelongate opening extending through the side wall, a recessed portion ofthe side wall being defined by wall portions extending inwardly from anouter contour of the intervertebral implant to the hollow space, theelongate opening extending between the wall portions, the intervertebralimplant further comprising at least two guiding surfaces extending alongan end of the intervertebral implant in an arc-shaped manner and facingone another such that the elongate opening extends therebetween, whereinthe device comprises: a drive shaft including an engagement portionconfigured to engage the intervertebral implant in the hollow space; anda sleeve movably holding and guiding the drive shaft and having alongitudinal axis, wherein the sleeve comprises an engagement structureconfigured to engage and slide along the at least two guiding surfacesand shaped to prevent rotation of the sleeve relative to the at leasttwo guiding surfaces about the longitudinal axis, when the engagementportion is received in the hollow space through the elongate opening androtated by an angle about the longitudinal axis such that the engagementportion is supported in the hollow space.
 44. The system according toclaim 43, wherein the hollow space has a center point, and wherein eachof the at least two guiding surfaces includes a first portion at whichthe outer contour is concentric about a longitudinal axis of theintervertebral implant extending through the center point, and each ofthe at least two guiding surfaces further includes a second portion atwhich the outer contour is recessed from a concentric shape about thelongitudinal axis of the intervertebral implant, such that a radialdistance from the outer contour at the second portion to thelongitudinal axis of the intervertebral implant is less than a radialdistance from the outer contour at the first portion to the longitudinalaxis of the intervertebral implant to allow latching-in of a portion ofthe sleeve.
 45. The system according to claim 44, wherein a distal endface of the sleeve comprises a substantially annular shape and includes:a planar surface portion configured to engage the second portion of aguiding surface of the at least two guiding surfaces which extends in astraight direction; and a concave surface portion having a curvaturecorresponding to the first portion of each of the at least two guidingsurfaces.
 46. The system according to claim 43, wherein at least one ofthe top surface or the bottom surface has a hole to allow visual accessto the engagement portion in the hollow space.
 47. The system accordingto claim 43, wherein the engagement portion includes at least oneprojection extending from a distal end face of the sleeve in a directionalong the longitudinal axis of the sleeve, wherein the at least oneprojection defines two guiding faces arranged at respective ends of theat least one projection in a circumferential direction and spaced at afirst distance from each other corresponding to a second distancebetween the at least two guiding surfaces.
 48. The system according toclaim 43, wherein the drive shaft is rotatable with respect to thesleeve about the longitudinal axis of the sleeve.
 49. A method ofinserting an intervertebral implant into a body using a device, theintervertebral implant including a top surface, a bottom surface, and aside wall extending between the top surface and the bottom surface, theintervertebral implant having a hollow space having a spherical segmentshape formed within the intervertebral implant and accessible through anelongate opening extending through the side wall at an end of theintervertebral implant, the intervertebral implant further including atleast two guiding surfaces extending along the end of the intervertebralimplant in an arc-shaped manner and facing one another, the deviceincluding a drive shaft including an engagement portion configured toengage the intervertebral implant in the hollow space; and a sleevemovably holding and guiding the drive shaft and having a longitudinalaxis, the sleeve including an engagement structure configured to engageand slide along the at least two guiding surfaces, the methodcomprising: inserting the engagement portion in the hollow space; androtating the drive shaft by an angle about the longitudinal axis suchthat the engagement portion is supported in the hollow space, wherein,when the engagement portion is supported in the hollow space, theengagement structure engages the at least two guiding surfaces toprevent rotation of the sleeve relative to the at least two guidingsurfaces about the longitudinal axis.
 50. The method according to claim49, further comprising sliding the engagement structure along the atleast two guiding surfaces.